Gallbladder disease continues to be one of the most common digestive disorders seen by physicians in this country. Approximately 500,000 cholecystectomies are performed each year in the United States. After conventional major abdominal surgery, patients experience considerable discomfort and their recovery time is lengthy. To address this problem, principles of laparoscopy have recently been applied to cholecystectomy.
Therapeutic laparoscopy for gallstone disease was reported by Morris in 1988 in which he described the procedure which allowed the laparoscopist to cannulate the gallbladder directly and remove gallstones, leaving the organ in situ. Laparoscopic removal of the gallbladder was initially performed in the U.S. by Saye and McKernan in 1988. Endocholecystectomy has evolved rapidly since 1988, along with the development of laparoscopic instrumentation and advances in video technology, contributing to the improved safety and quick adoption by general surgeons of this new procedure. Because of the tremendous advantages of endocholecystectomy, this procedure may rapidly replace open cholecystectomy as the procedure of choice.
In contrast to other, non-operative alternatives to the treatment of cholelithiasis, there are relatively few absolute contraindications to endocholecystectomy. This is because the surgeon can elect to convert the laparoscopic procedure to open cholecystectomy after an initial laparoscopic evaluation of the gallbladder and surrounding structures. Situations discovered at laparoscopy that may prompt such a decision include extensive adhesions caused by prior surgery or recurring attacks of cholecystitis, unusual vascular or ductal anatomy, other unsuspected pathology in the abdomen, acute inflammation, excessive bleeding, or the inability to safely identify the ductal or vascular anatomy.
Endocholecystectomy is performed under sterile conditions in a fully equipped operating room. In general, an operating laparoscope (generally 10 or 11 mm in diameter) with an attached camera is inserted through a canula to confirm intraperitoneal placement. Various laparoscopic instruments are then inserted through accessory canulae, to manipulate and dissect the gallbladder or other important anatomical structures.
Surgical procedures may be performed to excise and remove gallstones, rather than removing the entire gallbladder. To effect such removal, the gallbladder is opened, allowing stones to pass out of the gallbladder. The stones must then be removed from the abdomen. It is often difficult to collect stones, particularly when multiple stones are released, and successfully remove them from the abdomen.
The removal procedure generally requires removal of one stone at a time, relying on gentle vacuum to retain a stone at the tip of a vacuum tube for movement away from the gallbladder into an attached trocar for removal from the body. During this laborious task, stones are often lost within the body.
Procedures to remove the entire gallbladder are often hampered because the gallbladder is distended with bile or multiple stones and is too large to easily pass through a 10 mm or 11 mm surgical canula. In this situation, the surgeon may open the gallbladder to remove stones and aspirate fluid, collapsing or further dissecting gallbladder tissue prior to removal. Frequently during such manipulations stones are lost because of the difficulty in aspirating multiple stones being released from the gallbladder or multiple pieces of gallbladder tissue.
It would be of great utility to provide a device for retrieving and removing gallstones and gallbladder tissue during gallbladder surgery, particularly during laparoscopic endocholecystectomy.